Provider Demographics
NPI:1083261119
Name:RAQUEL A BRAVO DMD PA
Entity Type:Organization
Organization Name:RAQUEL A BRAVO DMD PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAQUEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:BRAVO
Authorized Official - Suffix:
Authorized Official - Credentials:DMD
Authorized Official - Phone:786-385-9522
Mailing Address - Street 1:10711 SW 27TH ST
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33165-2407
Mailing Address - Country:US
Mailing Address - Phone:786-385-9522
Mailing Address - Fax:786-507-1551
Practice Address - Street 1:10511 SW 88TH ST STE C101
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33176-1537
Practice Address - Country:US
Practice Address - Phone:786-507-1551
Practice Address - Fax:786-507-1554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-22
Last Update Date:2019-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1223G0001XDental ProvidersDentistGeneral PracticeGroup - Single Specialty